Good volume, poor nutrition

iVillage Member
Registered: 01-14-2009
Good volume, poor nutrition
5
Fri, 02-22-2013 - 10:54pm

Hello!  I have am looking for some advice about nursing my 7 month old daughter.  She has been exclusively breast fed and was doing alright with her weight checks until her 6 month appointment.  The Dr said that she was not gaining weight appropriately and so, he had us feed her formula for a week to see if that would increase her weight.  She had 30 oz of formula/day and at the end of the week she had gained more weight then the Dr had hoped.  So the next week he had us feed her all the breastmilk I had pumped (30 oz/day) and at the end of that week she weighed exactly the same.  She did not gain even an ounce!  The Dr said the easest way to ensure that she contine to gain weight is to swich to formula.  Or, I could talk to an LC and see if they had any suggestions.  Like I said, we bottle fed her all the milk I had pumped so I knew how much she was getting so its not a problem of her not taking in enough when nursing.  My other two daughters recieved only breastmilk for the first year and they never had any problems with gaining weight.  I really don't want to give up on nursing, but I also don't want to feed her anything the won't help her to grow.  I have always eaten about the same so I don't think that has anything to do with it.  Can my milk really have such poor nutrition?!  Any suggestions?

Thanks,

Lisa

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iVillage Member
Registered: 06-10-2008
Sun, 02-24-2013 - 8:16am

Lisa, welcome to the board and thanks for stopping by. Would it be ok if I asked a bunch of questions to start?

- About how many times a day would you guess you're currently nursing?

- Tell us more about the poor weight gain. Do you know if your dr. uses the CDC growth charts (old ones modeled after formula babies) or the WHO growth charts (newer ones modeled after how a breastfed baby grows)? Can you give us a full weight history?

- What is her solids intake at this point?

- Are you using any hormonal birth control?

This one is admittedly a bit puzzling to me. Hang in there!

Dana

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iVillage Member
Registered: 12-21-2009
Sun, 02-24-2013 - 3:58pm

Wow, I have to say your question is really challenging. Normally breast milk is the same or more calories than formula.

I just want to clarify to be sure I understand correctly.

The first week you gave the baby 30oz of formula per each 24 hours.

The second week you gave the baby 30oz of breast milk via bottle each 24 hours.

It would be exceedingly rare for a mom to have poor quality or low calorie breast milk. It’s hard to make the components of breast milk change with diet changes.

The only thing I can think of is to have a crematocrit done. This measures the fat level and therefore the calorie level of a mom’s milk. This is done in some NICU’s but I’m not sure if a standard lab would be able to do it for you.

Another thought would be to pump before each breastfeeding session to allow the baby to get a higher fat content in her milk.

I too am interested in how many times per day the baby breastfeeds (or was breastfeeding before the concerning weight) and how much solids she is getting and when you started the solids.

Also, what were her weights prior to the concern and after.

It’s not uncommon for babies to slow their weight gain pattern at this age, especially after starting solids which are generally less calorie dense.

I have to say your baby certainly looks healthy in her pictures.

I think it would be good to see an LC in your local area just so she can work directly with you and your pediatrician.

One more question. Were all the weights on the same scale naked? Was the scale properly zeroed. Your problem is so unusual it makes me think there might have been a scale issue.

Please get back and clarify our questions.

Warmly,

Kathy Kuhn IBCLC

iVillage lactation consultant

and Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, Silas and Charlotte    

Kathy Kuhn IBCLC ivillage lactation consultant Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, Silas, and Charlotte

iVillage Member
Registered: 02-22-2013
Tue, 02-26-2013 - 8:58pm

Hi Dana!  Thanks for replying.  I too am quite puzzled by this situation.  Here are the answers to your questions:

Right now we have Lily on formula as the dr suggested, but prior to that I was nursing her 4 times daily and my husband would give her 2-3 bottles of breast milk while I was at work.

I'm not really sure what growth chart my pediatrician uses.  Here is her weight history:

Birth (7/7/12):  7lbs 1oz

8/7:  8lbs 13oz

9/7:  10lbs 3oz

11/14:  11lbs 10oz

11/27:  12lbs 1oz

12/19:  12lbs 11oz

1/11:  12lbs  15oz  (this is where the pedi suggested using formula)

1/17:  13lbs 5oz (after 1 week of formula; 30oz/day)

1/25:  13lbs 5oz (after 1 week of bottle fed breast milk; 30oz/day)

2/8:  14lbs  (after formula only)

Before all this happened, she wasn't really taking in any meaningful solids.  Just a spoonful here and there.  Recently, we started giving her an ounce of solids 2-3 times daily.

I'm on Camila birth control pills.

When I had my first daughter, she wouldn't nurse so I exclusively pumped a year for her.  I would have no problem doing that again for Lily as long as the milk is helping her to grow.  Is there any way to have the milk tested for nutrition content?  Can I mix breast milk with the formula?  Have you ever heard of a mom switching to formula not because she wasn't producing enough milk but because the baby wasn't growing on it?  If it ends up that she does need to be on formula it won't be the end of the world.  I just want to make sure I've tried my best to figure this out and fix it if I can.

 

Thanks!

iVillage Member
Registered: 06-10-2008
Wed, 02-27-2013 - 11:19am

I'm going to start by just doing the math for Kathy.

0-16 WEEKS- TYPICAL GAIN 5-7 OUNCES/WEEK, all good

Birth (7/7/12):  7lbs 1oz

8/7:  8lbs 13oz - 6,4 oz gain/week

9/7:  10lbs 3oz - 4.9 oz gain/week

17-26 WEEKS - TYPICAL WEIGHT GAIN 4-5 OZ/WEEK

11/14:  11lbs 10oz - 2.4 oz gain/week

 11/27:  12lbs 1oz - 3.9 oz gain/week

12/19:  12lbs 11oz - 3.1 oz gain/week

26-52 WEEKS - TYPICAL GAIN 2-4 OZ/WEEK

1/11:  12lbs  15oz  (this is where the pedi suggested using formula) - 1.2 oz gain/week

1/17:  13lbs 5oz (after 1 week of formula; 30oz/day) - 7.5 oz gain/week

1/25:  13lbs 5oz (after 1 week of bottle fed breast milk; 30oz/day) - no gain

2/8:  14lbs  (after formula only) - 5.5 oz gain/week

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iVillage Member
Registered: 12-21-2009
Wed, 02-27-2013 - 8:56pm

Thanks Dana! You know how I hate doing the math!

I want to check something out about the birth control pills you are taking but my information is at my hospital job. So hang in there a bit and I’ll get back to you.

More questions. Did you take the pill when you breastfed your older child?

How much are you pumping daily? Is it easy to pump the 30 oz or are you barely keeping up? How many minutes do you pump?

I was wondering what would happen if you just used the milk from the last ¾ of the time you pump. So for example if you pump 20 minutes, put the first 5 minutes of your milk aside and freeze for another time and use the milk from the last 15 minutes to feed the baby. That should increase the fat and calorie content of the milk.

When you breastfeed directly you could pre-pump for about 5 minutes and then breastfeed as usual. If you think you could do that you might try that for a week and see what the weight is.

In the meantime I’ll do some more research and get back to you. I’ve never heard of anyone whose breast milk was low in calories, especially considering you did fine with the first baby. Do you mind if I post about your situation on my professional group email? I’d love to get their input.

I’ll be back hopefully with more answers.

Warmly,

iVillage lactation consultant

and Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, Silas and Charlotte    

Kathy Kuhn IBCLC ivillage lactation consultant Grammy to Brennan, Elias, Elianna, Tahlia, Makenna, Maura, Silas, and Charlotte